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April 2019
A Peer-Reviewed Journal | cliniciansbrief.com
ECTOPARASITES
IN THIS ISSUE
IN RABBITS
Borrelia Burgdorferi
Seropositivity in a
Subclinical Dog
Designing Feline Physical
Activity Programs
Hypoalbuminemia: A
Differential Diagnosis List
Marijuana Intoxication Case
Copper Hepatopathy in a Dog
Volume 17 Number 4
THE OFFICIAL CLINICAL PRACTICE JOURNAL OF THE WSAVA
Ready. Aim.
CLARO.
®
Fight canine otitis externa with one big dose of love.
Claro® (florfenicol, terbinafine, mometasone furoate)
Otic Solution is the only FDA-approved, single-dose
treatment administered by you with guaranteed
compliance and no at-home treatments.
SPREAD THE LOVE IN YOUR CLINIC. Claro® is indicated for the treatment of otitis externa in dogs associated
with susceptible strains of yeast (Malassezia pachydermatis) and bacteria
Use Claro for your most
® (Staphylococcus pseudintermedius).
CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a
common Otitis cases. licensed veterinarian. CONTRAINDICATIONS: Do not use in dogs with known tympanic
membrane perforation. CLARO® is contraindicated in dogs with known or suspected
hypersensitivity to florfenicol, terbinafine hydrochloride, or mometasone furoate.
©2019 Bayer, Shawnee Mission, Kansas 66201
BayerDVM.com/Claro Bayer, the Bayer Cross and Claro are registered trademarks of Bayer. CL19207
See page 2 for product information summary.
PUBLISHER OF
CLINICIAN’S
BRIEF
TEAM
EDITOR IN CHIEF CHIEF VETERINARY DIRECTOR OF MANAGING EDITOR
J. SCOTT WEESE OFFICER & EDITOR INTEGRATIVE CONTENT SAMANTHA FARLEY
DVM, DVSc, DACVIM INDU MANI JENNIFER L. SCHORI MPS
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Ontario Veterinary College
Ontario, Canada
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in veterinary
medicine
April 2019 cliniciansbrief.com 1
(florfenicol, terbinafine, mometasone furoate)
Otic Solution
Antibacterial, antifungal, and anti-inflammatory
For Otic Use in Dogs Only
CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a
licensed veterinarian.
DESCRIPTION:
CLARO® contains 16.6 mg/mL florfenicol, 14.8 mg/mL terbinafine (equivalent to
OUR
16.6 mg/mL terbinafine hydrochloride) and 2.2 mg/mL mometasone furoate. Inactive
ingredients include purified water, propylene carbonate, propylene glycol, ethyl alcohol,
and polyethylene glycol.
AUTHORS
INDICATIONS:
CLARO® is indicated for the treatment of otitis externa in dogs associated with
susceptible strains of yeast (Malassezia pachydermatis) and bacteria (Staphylococcus
pseudintermedius).
DOSAGE AND ADMINISTRATION:
Shake before use.
CLARO® should be administered by veterinary personnel. JULIE ALLEN, BVMS, MS, MRCVS, DACVIM
Administer one dose (1 dropperette) per affected ear. The duration of effect should
last 30 days. (SAIM), DACVP, is a clinical assistant professor of
1.
2.
Clean and dry the external ear canal before administering the product.
Verify the tympanic membrane is intact prior to administration.
clinical pathology at Cornell University. She earned
3. Remove single dose dropperette from the package. her veterinary degree from University of Glasgow
4. While holding the dropperette in an upright position, remove the cap
from the dropperette. and her master’s degree from Iowa State University,
5. Turn the cap over and push the other end of the cap onto the tip of the
dropperette. where she completed a rotating internship in small
6. Twist the cap to break the seal and then remove cap from the
dropperette. animal medicine and surgery and a residency in
7. Screw the applicator nozzle onto the dropperette.
8. Insert the tapered tip of the dropperette into the affected external ear canal
small animal internal medicine. She also completed
9.
and squeeze to instill the entire contents (1 ml) into the affected ear.
Gently massage the base of the ear to allow distribution of the solution.
a residency in clinical pathology at North Carolina
10. Repeat with other ear as prescribed. State University. Dr. Allen focuses on cachexia/
Cleaning the ear after dosing may affect product effectiveness.
CONTRAINDICATIONS: anorexia, endocrinology, and hepatobiliary and
Do not use in dogs with known tympanic membrane perforation (see PRECAUTIONS).
CLARO® is contraindicated in dogs with known or suspected hypersensitivity to
pancreatic disease and has committed her career to
florfenicol, terbinafine hydrochloride, or mometasone furoate.
improving the diagnosis of disease.
WARNINGS:
Human Warnings: Not for use in humans. Keep this and all drugs out of reach of
children. In case of accidental ingestion by humans, contact a physician immediately.
differential diagnosis page 21
In case of accidental skin contact, wash area thoroughly with water. Avoid contact with
eyes. Humans with known hypersensitivity to florfenicol, terbinafine hydrochloride, or
mometasone furoate should not handle this product.
PETER S. CHAPMAN, BVetMed (Hons),
PRECAUTIONS:
Do not administer orally. DECVIM-CA, DACVIM, MRCVS, practices veteri-
The use of CLARO® in dogs with perforated tympanic membranes has not been
evaluated. The integrity of the tympanic membrane should be confirmed before nary internal medicine at a large multispecialty hos-
administering the product. Reevaluate the dog if hearing loss or signs of vestibular
dysfunction are observed during treatment. Use of topical otic corticosteroids has been pital in the Philadelphia area, serves as the director
associated with adrenocortical suppression and iatrogenic hyperadrenocorticism in
dogs (see ANIMAL SAFETY). of the residency program at Veterinary Specialty &
Use with caution in dogs with impaired hepatic function (see ANIMAL SAFETY).
The safe use of CLARO® in dogs used for breeding purposes, during pregnancy, or in
Emergency Center in Levittown, Pennsylvania, and
lactating bitches has not been evaluated.
is on the European College of Veterinary Internal
ADVERSE REACTIONS:
In a field study conducted in the United States (see EFFECTIVENESS), there were no Medicine examination committee. Dr. Chapman
directly attributable adverse reactions in 146 dogs administered CLARO®.
To report suspected adverse drug events and/or obtain a copy of the Safety Data Sheet has been published extensively on various internal
(SDS) or for technical assistance, contact Bayer HealthCare at 1-800-422-9874.
For additional information about adverse drug experience reporting for animal drugs, contact medicine topics. His interests include all aspects
FDA at 1-888-FDA-VETS or online at http://www.fda.gov/AnimalVeterinary/SafetyHealth.
PHARMACOLOGY:
of internal medicine, particularly endocrine and
CLARO® Otic Solution is a fixed combination of three active substances: florfenicol
(antibacterial), terbinafine (antifungal), and mometasone furoate (steroidal
hematologic disease.
anti-inflammatory). Florfenicol is a bacteriostatic antibiotic which acts by inhibiting
protein synthesis. Terbinafine is an antifungal which selectively inhibits the red light, green light page 62
early synthesis of ergosterol. Mometasone furoate is a glucocorticosteroid with
anti-inflammatory activity.
MICROBIOLOGY:
The compatibility and additive effect of each of the components in CLARO® solution
DAVID ESHAR, DVM, DABVP (ECM), DECZM
was demonstrated in a component effectiveness and non-interference study. An
in vitro study of organisms collected from clinical cases of otitis externa in dogs
(SM & ZHM), is an associate professor of compan-
enrolled in the clinical effectiveness study determined that florfenicol and terbinafine
hydrochloride inhibit the growth of bacteria and yeast commonly associated with
ion exotic pet and zoo animal medicine at Kansas
otitis externa in dogs. No consistent synergistic or antagonistic effect of the two
antimicrobials was demonstrated. The addition of mometasone furoate to the
State University. He earned his DVM from Hebrew
combination did not impair antimicrobial activity to any clinically significant extent. University in Israel before completing an internship
In a field study (see EFFECTIVENESS), at least 10 isolates from successfully treated
cases were obtained for S. pseudintermedius and M. pachydermatis. at Cummings School of Veterinary Medicine at Tufts
EFFECTIVENESS:
In a well-controlled, double-masked field study, CLARO® was evaluated against a University and a residency at University of Pennsyl-
vehicle control in 221 dogs with otitis externa. One hundred and forty six dogs were
treated with CLARO® and 75 dogs were treated with the vehicle control. All dogs vania. Dr. Eshar is the leading author or coauthor
were evaluated for safety. Treatment (1 mL) was administered once on Day 0 to the
affected ear(s). Prior to treatment, the ear(s) was cleaned with saline. The dogs were of nearly 100 scientific publications in all aspects
evaluated on Days 0, 7, 14, and 30. Blood work and urinalysis were obtained on Day 0
pre-treatment and Day 30 at study completion. Four clinical signs associated with otitis of clinical medicine of exotic, wild, and zoo-kept
externa were evaluated: erythema, exudate, swelling, and ulceration. Success was
based on clinical improvement at Day 30. Of the 183 dogs included in the effectiveness species. His professional interests include the care
evaluation, 72.5% of dogs administered CLARO® solution were successfully treated,
compared to 11.1% of the dogs in the vehicle-control group (p=0.0001). of invertebrate, fish, amphibian, reptile, and avian
ANIMAL SAFETY:
In a target animal safety study, CLARO® was administered aurally to 12-week-old Beagle
patients, as well as nondomestic mammals, in cap-
puppies (4 dogs/sex/group) at 0X, 1X, 3X, and 5X the recommended dose once every 2
weeks for a total dosing period of 28 days (3 times the treatment duration). No clinically
tivity. Dr. Eshar’s main clinical focus is to provide
relevant treatment-related findings were noted in hearing tests, body weight, weight
gain, or food consumption. CLARO® administration was associated with post-treatment
the highest level of medicine and surgery for com-
ear wetness or clear aural exudate, increased absolute neutrophil count, decreased
absolute lymphocyte and eosinophil counts, suppression of the adrenal cortical
panion exotic pets and zoo-kept species.
response to ACTH-stimulation, decreased adrenal weight and atrophy of the adrenal
cortex, increased liver weight with hepatocellular enlargement/cytoplasmic change, consult the expert page 12
and decreased thymus weight. Other potentially treatment-related effects included mild
changes to AST, total protein, inorganic phosphorus, creatinine, and calcium.
STORAGE INFORMATION:
Store between 20°C – 25°C (68°F – 77°F), excursions are permitted 15°C – 30°C
(59°F – 86°F).
HOW SUPPLIED:
CLARO® solution is supplied in a single-use dropperette in a blister. Each dropperette
contains one 1 mL dose.
CLARO® is available in cartons of two, ten, or twenty dropperettes.
Manufactured for
Bayer HealthCare LLC, Animal Health Division
P.O. Box 390 Shawnee Mission, Kansas 66201 USA.
Bayer, the Bayer Cross and CLARO are registered trademarks of Bayer
© 2018 Bayer
NADA 141-440, Approved by FDA
LV1802 2 cliniciansbrief.com April 2019
JULIEN GUILLAUMIN, DVM, DACVECC, DECVECC, is
an associate professor of emergency medicine and critical
care at The Ohio State University. He earned his DVM
from National Veterinary School of Nantes in Nantes,
France, and completed a small animal rotating internship
at National Veterinary School of Alfort in Maisons-Alfort,
France. Dr. Guillaumin completed a residency at Univer-
sity of California, Davis, and serves on the American
College of Veterinary Emergency Critical Care residency
training committee and the European College of Veteri-
nary Emergency and Critical Care education committee.
His clinical interests are hemostasis, blood banking and
blood products, immune-mediated hemolytic anemia,
thrombosis, and systemic inflammatory response syn-
drome, sepsis, and multiple organ dysfunction syndrome.
case in point page 34
DEBORAH E. LINDER, DVM, MS, DACVN, is a veterinary
nutritionist at Cummings School of Veterinary Medicine at
Tufts University, where she earned her DVM. She is also the
codirector of the Tufts Institute for Human–Animal Interac-
tion. She has spoken at national and international confer-
ences and has authored articles for numerous publications.
Dr. Linder’s clinical interests include obesity management,
effective pet owner education, and human–animal interac-
tion. Her research focuses on safe and effective weight-loss
strategies for pets, as well as the effects of obesity on pet and
human well-being.
consult the expert page 27
MEGAN STADLER, DVM, is an assistant professor of emer-
gency medicine and critical care at The Ohio State Univer-
sity, where she earned her DVM. Dr. Stadler is a member of
the European Veterinary Emergency and Critical Care Soci-
ety, the Veterinary Emergency and Critical Care Society, the
American College of Veterinary Radiology, and the Interna-
tional Veterinary Radiology Association. Her clinical inter-
ests include diagnostic imaging, toxicities, and polytrauma.
case in point page 34
J. SCOTT WEESE, DVM, DVSc, DACVIM, is the editor in
chief of Clinician’s Brief. He is also the chief of infection con-
trol at Ontario Veterinary College in Ontario, Canada, and a
veterinary internist and microbiologist. Dr. Weese’s research
interests are infectious and zoonotic disease, particularly of
companion animals, as well as infection control, staphylo-
coccal infections, Clostridium difficile infection, and anti-
microbial therapy. He holds a Canada Research Chair in
zoonotic disease.
case in point page 56 n
April 2019 cliniciansbrief.com 3
Profender® Topical Solution (emodepside/praziquantel)
Let’s face it,
pilling cats isn’t for everyone.
Fortunately, there’s Profender® – a broad-spectrum, topical dewormer for cats.
Profender® offers a purge deworming of tapeworms,
roundworms and hookworms. All in one single,
easy-to-apply topical application.†
• No pilling necessary
• No water chasers
• No messy yellow paste
• No painful injections
Tapeworms Roundworms Hookworms
A single treatment is effective and a second treatment should not be necessary.
†
If reinfection with worms occurs, Profender® can be applied after 30 days.
Federal law (U.S.A.) restricts this drug to use by or on the order
of a licensed veterinarian. Children should not contact application
site for twenty-four (24) hours.
©2018 Bayer, Shawnee Mission, KS 66201
Bayer, the Bayer Cross and Profender are registered trademarks of Bayer. P181581
See page 3 for product information summary.
IN THIS
ISSUE
ON THE COVER
CONSULT THE EXPERT
Ectoparasites
in Rabbits
David Eshar, DVM,
DABVP (ECM), DECZM
(SM & ZHM)
12
PG
21 DIFFERENTIAL DIAGNOSIS
Hypoalbuminemia
Julie Allen, BVMS, MS, MRCVS, DACVIM
34 CASE IN POINT
Marijuana Intoxication
in a Pit Bull
(SAIM), DACVP Megan Stadler, DVM
Julien Guillaumin, DVM, DACVECC,
27 CONSULT THE EXPERT
Physical Activity
DECVECC
Programs for Cats
Deborah E. Linder, DVM, MS, DACVN 56 CASE IN POINT
Borrelia Burgdorferi
Seropositivity in a
Clinically Normal Dog
J. Scott Weese, DVM, DVSc, DACVIM
62 RED LIGHT, GREEN LIGHT
Copper Hepatopathy
in a Labrador Retriever
Peter S. Chapman, BVetMed (Hons),
DECVIM-CA, DACVIM, MRCVS
April 2019 cliniciansbrief.com 5
ON
THE
WEB
THIS MONTH’S CLINICAL FEATURES
AVAILABLE ONLY ONLINE
QUIZ
Canine Uterine Disorders
Autumn P. Davidson, DVM, MS,
DACVIM
brief.vet/uterine-disorders
QUIZ
Brain Tumors in
Dogs & Cats
Mark Troxel, DVM, DACVIM
(Neurology)
brief.vet/brain-tumor
23
SYMPOSIUM CAPSULES
2019 VMX 02 OUR
AUTHORS
39 FROM PAGE TO PATIENT
Tips and techniques from
the research pages
08 GET SOCIAL
Currently on Clinician’s Brief
social media
55 PRACTICE HOTLINE
The latest in products and services
71 ADVERTISERS
INDEX
Contact us at
72 QUIZ
CORNER
editor@cliniciansbrief.com
Articles archived at
cliniciansbrief.com/journal
April 2019 cliniciansbrief.com 7From Clinician’s Brief
on Social Media
WE ASKED …
What is the strangest thing you have What is one thing you would
found in your pocket after a shift? change about your current job?
“We had a clinician who liked to secretly put dog testicles in “Sending medical records straight from my brain to the
veterinary nurses’ pockets.”—Emily C computer, with no typing involved.”—Kelly R
“Is it weird that the number of times I have found poop in my “Every animal would have health insurance, and there
pocket makes me consider it not strange enough for this would be no budget restrictions.”—Cath R
question? I did find poop in my wallet at the bank after a shift
“Compassion fatigue would not exist.”—Susan E
once. Luckily, I was in line and not at the teller.”—Justin D
“Actually leaving on time every day!”—Erin M
“A kidney! I was in an anatomy laboratory, and someone played a
joke on me by putting a dog kidney in my coat pocket.”—Mary N
“An owner’s phone number—put there without me knowing!”
—Anita N
“A pen. Seriously, they disappear like nobody’s business.”
—Cheralyn A A TELLTALE SIGN
OF A ROUGH DAY …
What is the most satisfying
moment of your day?
“Removing a tooth without breaking any roots.”—Erin C
“Converting a skeptical owner by finding a single flea on a cat
with a naked butt.”—Ali J
“When a blocked cat pees!”—Melissa A
“Getting the pet that has not eaten in 5 days to take a teeny
tiny nibble.”—Carolynn H
“When I find the person who stole my favorite pen and steal it
back from them.”—Alyssa W
FOLLOW US facebook.com/cliniciansbrief @CliniciansBrief clinicians.brief
8 cliniciansbrief.com April 2019THE ONLY CHOICE
YOU NEED TO MAKE.
TWO CONDITIONS, ONE SOLUTION
SATIETY HYDROLYZED PROTEIN
Managing cutaneous adverse food reactions is already complex,
and an overweight pet presents an additional challenge. Making
a decision about what diet to feed patients with both cutaneous
adverse food reactions and an overweight body condition can
be difficult.
Now you can manage both conditions at the same time with
the new Multifunction Satiety + Hydrolyzed Protein formula from
Royal Canin, the first and only hydrolyzed protein product in the
market formulated for weight loss, and the latest addition to our
Multifunction hydrolyzed protein diet line.
FIND OUT MORE AT ROYALCANIN.COM/MULTIFUNCTION
©ROYAL CANIN® SAS 2019. All Rights Reserved.chewables
CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian.
INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm
larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara
canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense).
DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the
recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate
salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm
disease and for the treatment and control of ascarids and hookworms is as follows:
Color Coding 0n
Dog Chewables Ivermectin Pyrantel Foil Backing
Weight Per Month Content Content and Carton
Introducing the Up to 25 lb
26 to 50 lb
51 to 100 lb
1
1
1
68 mcg
136 mcg
272 mcg
57 mg
114 mg
227 mg
Blue
Green
Brown
New Clinician’s Brief HEARTGARD Plus is recommended for dogs 6 weeks of age and older.
For dogs over 100 lb use the appropriate combination of these chewables.
CE Platform ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the
remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable,
the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food.
The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without
chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole.
Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few
Get affordable, RACE-approved minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the
dose has been lost, redosing is recommended.
HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors),
CE from the Clinician’s Brief potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days)
after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last
exposure to mosquitoes.
content you trust—without ever When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of
HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication.
leaving your desk.
If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for
optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment
is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the
recommended dosing regimen will minimize the opportunity for the development of adult heartworms.
Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T.
leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be
The Clinician’s Brief CE platform offers a taken to prevent reinfection with intestinal parasites.
EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against
personalized dashboard to keep track of the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development
of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and
lesson progress, earned hours, receipts, and hookworms (A. caninum, U. stenocephala, A. braziliense).
ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form
certificates and to view the latest available that was consumed at first offering by the majority of dogs.
PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with
courses. Current lesson topics include HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult
heartworms and microfilariae before initiating a program with HEARTGARD Plus.
lymphoma, diagnosing and managing While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level,
HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due
hyperadrenocorticism, and nasal discharge to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with
ivermectin alone after treatment of some dogs that have circulating microfilariae.
and nasal planum disease. Each CE lesson Keep this and all drugs out of the reach of children.
In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a
Poison Control Center for advice concerning cases of ingestion by humans.
includes articles, videos, or webinars on a Store between 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect
product from light.
particular topic, from cardiology to client ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of
dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported
communication. following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering,
convulsions and hypersalivation.
SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability
of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6
Scan the QR code or visit mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of
ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds.
cliniciansbrief.com/ce to create
At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors,
drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at
10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies,
your dashboard and start support the safety of HEARTGARD products in dogs, including Collies, when used as recommended.
HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant
earning CE today! or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea
collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with
HEARTGARD Plus in a heartworm disease prevention program.
In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes,
Using QR codes from your mobile device is easy possibly due to a change in intestinal transit time.
and quick! HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different
weights. Each strength comes in convenient cartons of 6 and 12 chewables.
Simply focus your phone’s camera on the QR For customer service, please contact Merial at 1-888-637-4251.
code as if taking a picture (but don’t click!). A
®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial.
notification banner will pop up at the top of your ©2015 Merial, Inc., Duluth, GA. All rights reserved.
screen; tap the banner to view the linked content.THE PROTECTION
DOGS COME
RUNNING FOR.
The only Real-Beef Chewable isn’t just the #1 choice
of dogs,1 owners,2 and veterinarians3 - it’s the one dogs
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3 Protects dogs from heartworm disease and treats
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3 Is approved for puppies as young as 6 weeks of age
3 Over 30 years of trusted prevention
1
Freedom of Information: 2
Data on file at 3
Data on file at
NADA140-971 (January Boehringer Ingelheim. Boehringer Ingelheim.
15, 1993). IMPORTANT SAFETY INFORMATION: HEARTGARD® Plus (ivermectin/pyrantel) is
HEARTGARD and the Dog & Hand logo are
® ® well tolerated. All dogs should be tested for heartworm infection before starting
registered trademarks of Boehringer Ingelheim a preventive program. Following the use of HEARTGARD Plus, digestive and
Animal Health USA Inc. ©2019 Boehringer
Ingelheim Animal Health USA, Inc., Duluth, GA. neurological side effects have rarely been reported. For more information, please
All rights reserved. PET-1309-HGD0319. see full prescribing information or visit www.HEARTGARD.com.
See page 10 for product information summary.CONSULT THE EXPERT ECTOPARASITES IN RABBITS David Eshar, DVM, DABVP (ECM), DECZM (SM & ZHM) Kansas State University
D
ermatologic diseases are
among the most common
clinical presentations in
rabbits (Oryctolagus cuniculus).
Most dermatoses in rabbits occur
secondary to parasitic infestation.1CONSULT THE EXPERT h PARASITOLOGY/DERMATOLOGY/EXOTIC ANIMAL MEDICINE h PEER REVIEWED
Many clinical presentations in rabbits result from of any past diseases, treatment, whether other
suboptimal husbandry (eg, environment, diet)2; animals in the household are also showing
therefore, a thorough review of patient husbandry dermatologic signs) can also be beneficial. Once
is critical for successful diagnosis and treatment of identified, any husbandry deficiencies should be
dermatoses and/or parasitic infestation. The owner corrected and the environment treated (eg, cage
should be questioned about the patient’s caging sys- cleaned, bedding removed, other animals in the
tem, substrate, bedding, and diet and whether the household evaluated) to control the parasitic
patient is indoor, outdoor, or both. More targeted infestation and prevent recurrence.2,3
questions pertaining to skin disease (eg, duration
Clinical Signs
Rabbits infested with ectoparasites can show a vari-
ety of clinical signs, most commonly pruritus, scal-
ing or crusting, hair loss, erythema, excoriations,
erosions, alopecia, and/or nodules (Figure 1).2-6
Pruritus is the most common clinical sign associ-
ated with ectoparasites in rabbits2-4; thus, recogni-
tion of pruritus in patients, in other animals in
contact with the patient, or in the owner is crucial.
Diagnosis
A detailed dermatologic examination is necessary
in all rabbits presented with skin disease suspected
to be secondary to parasitic infestation. Because
rabbits are prone to being fractious, safe restraint
is required to obtain quality diagnostic skin sam-
ples, and anesthesia or sedation may be indicated
in some patients.2-6
d FIGURE 1 Focal dermal lesions of alopecia and scaling in a rabbit infested
with skin mites Several useful dermatologic diagnostic tests,
including impression smears, are available for
rabbits. Direct slide impressions are often used in
patients with moist, exudative, or crusted lesions.
A moistened swab can also be used to collect cyto-
logic samples, which can then be rolled onto a
slide. Brushed hair and debris can be useful for
detection of superficial ectoparasites (eg, certain
mites, lice) and their eggs. Skin scrapings (Figure
2), both superficial (ie, collection of oiled debris)
and deep (ie, down to dermal capillary bleeding),
can also be useful in the detection of ectoparasites
and their eggs. Because rabbits have thin skin, a
dulled scalpel blade or a scraping spatula should
be used to perform skin scrapings. Bacterial cul-
ture and susceptibility testing can be useful for
d FIGURE 2 Skin scrape using a dulled #10 scalpel blade to collect hair and samples collected from any exudative, crusted,
skin debris before microscopic examination nodular, or cystic lesion. A trichogram can be used
14 cliniciansbrief.com April 2019to evaluate for ectoparasites and dermatophytosis Ticks
(eg, fungal hyphae, ectothrix) and for broken or Many species of ticks feed on rabbits (Figure 4).
fractured hair ends that would help determine The most common in North America to feed on
whether hair loss is traumatic. Acetate tape impres- rabbits is the continental rabbit tick (Haemaphysa-
sions are preferred for drier lesions and can be lis leporispalustris).2,4,6 Rabbits can serve as hosts
useful in the detection of superficial ectoparasites for each stage of the continental rabbit tick’s life
and their eggs, particularly Cheyletiella spp. Other cycle, although the tick must leave the rabbit after
common diagnostic tests include fungal culture, feeding to develop and molt between each stage.
Wood’s lamp, skin biopsies for histopathology,
and clinical pathology testing, including CBC and
serum chemistry profile, as some skin lesions may
be reflective of systemic disease.
Discussion
Skin disease in rabbits can be caused by infestation
of several different types of parasites, including,
fleas, lice, ticks, and mites.
Fleas
Pet rabbits may commonly acquire Ctenocephalides
spp if in the same household as a carrier dog or cat.
Various flea species, including the rabbit flea (Spilo-
psyllus cuniculi), the common Eastern rabbit flea
(Cediopsylla simplex), the giant Eastern rabbit flea
(Odontopsyllus multispinosus), and the sticktight
flea (Echidnophaga gallinacea), may be found on pet
rabbits that are housed outside or that have been
exposed to wild rabbits. S cuniculi infestations are d FIGURE 3 Lice between parted hair on physical examination of an animal
common in rabbit colonies.2 The life cycle of this presented for pruritus
flea is influenced by the hormonal cycle of the host,
with sudden proliferation seen in pregnant does
and young rabbits. In endemic areas, S cuniculi is a
vector for myxomatosis.2 Flea-infested rabbits often
are clinically normal, have pruritus, or display a
poor coat. Diagnosis is made via flea removal and
microscopic identification.
Lice
Infestations by Haemodipsus ventricosus, a sucking
louse, are common in wild lagomorphs but rare in
pet rabbits (Figure 3). Pruritus, erythema, papules,
alopecia, and, rarely, anemia may be present in
infested rabbits. Lice may also act as a vector for
tularemia (Francisella tularensis).2,6 Diagnosis is
made via microscopic visualization of the lice and d FIGURE 4 A Rhipicephalus sanguineus tick (ie, brown dog tick) on the
eggs (ie, nits).2 medial ear pinna of a rabbit allowed outdoors during mild weather
April 2019 cliniciansbrief.com 15CONSULT THE EXPERT h PARASITOLOGY/DERMATOLOGY/EXOTIC ANIMAL MEDICINE h PEER REVIEWED
Tick infestation can cause anemia, and ticks also
serve as vectors for myxomatosis, papillomavirus,
and tularemia. Ticks should be physically removed
from rabbits.2,4,6 Because of the potential presence
of zoonotic pathogens (eg, Rickettsia rickettsii,
Francisella tularensis), it is crucial that clinicians
ensure proper tick removal with forceps or a
tick-removal instrument.
Mites
The nonburrowing ear mite Psoroptes cuniculi is
one of the most common causes of dermatologic
disease and a frequent cause of otitis externa in
d FIGURE 5 Severe presentation of sarcoptic mange on the feet of an
rabbits.6 Typical clinical signs include pruritic
affected rabbit
otitis with thick crusts on the ear pinna.2,6 Neuro-
logic signs may be exhibited in patients with puru-
lent otitis media and/or tympanum perforation.
Other skin involvement may be seen on the face,
neck, and/or external genitalia. Mites can be
observed through microscopic examination of
crusts or skin scrapings.2,4,6
Sarcoptic acariasis from the burrowing mite
Sarcoptes scabiei var cuniculi can also occur in pet
rabbits4 and results in a highly pruritic, hyper-
keratotic dermatosis that often initially affects the
skin around the face, feet, and external genitalia
(Figure 5).6 This zoonotic ectoparasite can cause
d FIGURE 6 A rabbit showing mild bilateral scaling on the ear pinna. The an intense papular pruritus often on the limbs and
patient was later diagnosed with the rabbit mite Cheyletiella parasitovorax
torso of affected humans. Mites can be observed
via skin scraping and microscopic examination.
through microscopic examination of superficial
and deep skin scrapings.3,4
Cheyletiella parasitovorax, the rabbit fur mite, is a
nonburrowing mite that can sometimes be visible
to the naked eye as “walking dandruff.” Some rab-
bits can be subclinical carriers, but patients with
heavy infestations may have mild crusting and
scaling along the dorsum, variable pruritus, and
partial alopecia (Figure 6).2-4,6 This zoonotic mite
can cause pruritic papular dermatitis in humans
and can also be transferred to other animals in the
household.3,7 The mites can be observed on micro-
scopic examination of superficial skin scrapings
or cellophane tape samples (Figure 7).2
d FIGURE 7 Microscopic image of Cheyletiella parasitovorax, the rabbit fur mite
16 cliniciansbrief.com April 2019Leporacarus gibbus is a nonburrowing fur-clasping Infestation by the mite Ornithonyssus bacoti is
mite that is usually nonpathogenic but may cause common in small rodents and laboratory rabbit
alopecia and scaling.4,6 This zoonotic ectoparasite colonies but is rarely observed in pet rabbits.3,6
can cause dermatosis with papular urticaria in Infested rabbits show intense pruritus, general-
humans.7 Mites can be seen on microscopic exam- ized alopecia, crusts, and secondary dermatitis.
ination of skin scrapings, trichogram, or acetate Heavy infestation may lead to severe anemia.
tape impression.2 Diagnosis is made through microscopic examina-
tion of skin scrapings, trichogram, or acetate tape
Demodicosis (Demodex cuniculi) in rabbits is often impression.3,6
subclinical, and rabbits with dermal lesions (eg, pru-
ritus, crusting) are often affected by other systemic Other mites such as Psorobia lagomorphae and Notoe-
illnesses. Diagnosis is made via microscopic exam- dres cati var cuniculi are rarely observed in rabbits
ination of deep skin scrapings and trichogram.2 but, when present, can cause pruritic dermatosis.2,6
TABLE
ANECDOTAL, EXTRA-LABEL ECTOPARASITE TREATMENT OPTIONS IN RABBITS2,3,6,7
Drug Dosage Ectoparasite Treating Against
Doramectin 0.2-0.3 mg/kg SC once Psoroptes spp mites
0.2 mg/kg PO once L gibbus and Psoroptes spp mites
Eprinomectin 0.2-0.3 mg/kg SC once or 0.5 mg/kg every Psoroptes spp mites
2 to 3 weeks based on response to treatment
Fipronil Contraindicated; can cause CNS signs and
death in rabbits7
Fluralaner 20 mg/kg PO once Psoroptes spp mites
Imidacloprid 10-16 mg/kg topically once or weekly as needed Adult fleas
Imidacloprid + moxidectin Imidacloprid (10 mg/kg) + moxidectin (1 mg/kg Psoroptes spp mites
topically) every 4 weeks for 3 treatments
Imidacloprid + permethrin 11-16 mg/kg topically once L gibbus
Ivermectin 0.2-0.4 mg/kg SC every 10 to 14 days for 3 treatments Adult mites, lice, ticks
Lufenuron 30 mg/kg PO every 30 days Flea larva
Moxidectin 0.2-0.3 mg/kg SC every 10 to 14 days for 3 treatments Adult mites
0.2 mg/kg PO every 10 days for 2 treatments Psoroptes spp mites
Selamectin 12 mg/kg topically once Cheyletiella spp
20 mg/kg topically once a week Fleas
8-14 mg/kg topically every 30 days for 2 treatments Sarcoptes spp mites
6-18 mg/kg topically once Psoroptes spp mites
April 2019 cliniciansbrief.com 17CONSULT THE EXPERT h PARASITOLOGY/DERMATOLOGY/EXOTIC ANIMAL MEDICINE h PEER REVIEWED
Treatment
Most cases of antiparasitic treatment in rabbits
have reportedly involved use of products that were POLL
not originally labeled for use in rabbits, and most
Which of the following ectoparasites do you
chosen treatment options are based on clinical
see most often in your rabbit patients?
experience or few available clinical trials. Practi-
cal antiparasitic treatment options derived from A. Fleas
extra-label reports and the author’s experience are B. Lice
detailed in the Table, previous page. C. Ticks
D. Mites
Follow-Up & Monitoring E. I have never seen ectoparasite
Weekly monitoring of rabbits infested with infestations in my rabbit patients.
ectoparasites is indicated, as many ectoparasitic F. I do not see rabbit patients.
conditions in rabbits have a profound effect on the
animal’s quality of life, can become complicated, Scan the QR code to submit your answer and see the
and, although rare, can pose a zoonotic concern. other responses! The poll is located at the bottom of
In addition to monitoring the progression of the the article.
patient’s presenting clinical signs and efficacy of Using QR codes from your mobile
treatment, clinicians should inquire about poten- device is easy and quick!
tial environmental treatments, other animals in
Simply focus your phone’s camera on
the household, and any other concerns raised by
the QR code as if taking a picture (but
the owner. n
don’t click!). A notification banner will pop up at the
top of your screen; tap the banner to view the linked
content.
References
1. Snook TS, White SD, Hawkins MG, et al. Skin diseases in pet 4. Jenkins JR. Skin disorders of the rabbit. Vet Clin North Am Exot Anim
rabbits: a retrospective study of 334 cases seen at the University of Pract. 2001;4(2):543-563.
California at Davis, USA (1984-2004). Vet Dermatol. 2013;24(6):613- 5. Rosen LB. Dermatologic manifestations of zoonotic diseases in
617, e148. exotic animals. J Exot Pet Med. 2011;20(1):9-13.
2. Palmeiro BS, Roberts H. Clinical approach to dermatologic disease 6. White SD, Bourdeau PJ, Meredith A. Dermatologic problems of
in exotic animals. Vet Clin North Am Exot Anim Pract. 2013;16(3):523- rabbits. Semin Avian Exot Pet Med. 2002;11(3):141-150.
577.
7. Elhawary NM, Sorour SS, Bazh EK, et al. Toxicity of fipronil in
3. Fehr M, Koestlinger S. Ectoparasites in small exotic mammals. Vet rabbits as a therapeutic drug for Psoroptes cuniculi: a preliminary
Clin North Am Exot Anim Pract. 2013;16(3):611-657. observation. J Exper Appl Anim Sci. 2018;2(3):260-265.
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18 cliniciansbrief.com April 2019RECOMBITEK
®
MEANS
PURE.
TARGETED
LYME
PROTECTION
RECOMBITEK Lyme has all the
protection dogs need, and none of the
antigens they don’t.
THE ONLY canine Lyme vaccine that
is nonadjuvanted and contains a single
protein, lipidated OspA
A lipidated form of OspA has been
shown to be more immunogenic than
a nonlipidated form of OspA1
Effective protection that blocks
Borrelia burgdorferi while it’s still in
the tick2
1
Grosenbaugh DA, De Luca K, Durand P-Y et al. Characterization of recombinant OspA in
two different Borrelia vaccines with respect to immunological response and its relationship
to functional parameters. BMC Veterinary Research. 2018;14:312. https://doi.org/10.1186/
s12917-018-1625-7. Accessed November 7, 2018.
2
Rice Conlon JA, Mather TN, Tanner P. Efficacy of a nonadjuvanted outer surface protein
A, recombinant vaccine in dogs after challenge by ticks naturally infected with Borrelia
burgdorferi.* Vet Ther. 2000;1(2):98-107.
RECOMBITEK® is a registered trademark of Boehringer Ingelheim Animal Health USA Inc.
©2019 Boehringer Ingelheim Animal Health USA Inc. All rights reserved. PET-0911-REC0119.CHEW OR TOPICAL SOLUTION
Pet owners already have a lot to remember.
Give them one less thing to forget.
Protect your patients from fleas & ticks for up to 12 weeks* with BRAVECTO®
Ask your Merck Animal Health Rep about BRAVECTO or Visit Bravectovets.com
*BRAVECTO kills fleas and prevents flea infestations for 12 weeks. BRAVECTO Chew and BRAVECTO Topical Solution for Dogs kill ticks (black-legged tick, American dog tick,
and brown dog tick) for 12 weeks and also kill lone star ticks for 8 weeks. BRAVECTO Topical Solution for Cats kills ticks (black-legged tick) for 12 weeks and American dog ticks for 8 weeks.
IMPORTANT SAFETY INFORMATION: BRAVECTO has not been shown to be effective for 12-weeks’ duration in puppies or kittens less than 6 months of age. BRAVECTO Chew: The most
common adverse reactions recorded in clinical trials were vomiting, decreased appetite, diarrhea, lethargy, polydipsia, and flatulence. BRAVECTO is not effective against lone star ticks beyond
8 weeks of dosing. BRAVECTO Topical Solution for Dogs: The most common adverse reactions recorded in clinical trials were vomiting, hair loss, diarrhea, lethargy, decreased appetite, and
moist dermatitis/rash. BRAVECTO is not effective against lone star ticks beyond 8 weeks of dosing. For topical use only. Avoid oral ingestion. Use caution in dogs with a history of seizures. Seizures
have been reported in dogs receiving fluralaner, even in dogs without a history of seizures. BRAVECTO Topical Solution for Cats: The most common adverse reactions recorded in clinical trials
were vomiting, itching, diarrhea, hair loss, decreased appetite, lethargy, and scabs/ulcerated lesions. BRAVECTO is not effective against American dog ticks beyond 8 weeks of dosing. For topical use
only. Avoid oral ingestion. The safety of BRAVECTO has not been established in breeding, pregnant and lactating cats. Use with caution in cats with a history of neurologic abnormalities. Neurologic
abnormalities have been reported in cats receiving BRAVECTO, even in cats without a history of neurologic abnormalities. See full Prescribing Information on page 22.
Copyright © 2018 Intervet Inc. d/b/a Merck Animal Health, a subsidiary of Merck & Co. Inc. All rights reserved. US/BRV/0218/0036DIFFERENTIAL DIAGNOSIS h INTERNAL MEDICINE/CLINICAL PATHOLOGY h PEER REVIEWED
Hypoalbuminemia
Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP
Cornell University
FOR MORE Following are differential
Find more Differential
Diagnosis lists in diagnoses, listed in
upcoming issues of order of likelihood, for
Clinician’s Brief and on
patients presented with
cliniciansbrief.com
hypoalbuminemia.
h Panting
h Hypercholesterolemia
h Hypocholesterolemia Increased loss
h References
h Neutropenia Klosterman ES, Moore GE, de Brito Galvao J, et al.
• P rotein-losing nephropathy (eg,
Comparison of signalment, clinicopathologic
h Decreased Total
glomerulonephritis, Lyme nephritis) findings, histologic diagnosis, and progno-
Thyroxine • P rotein-losing enteropathy (eg,
sis in dogs with glomerular disease with or
without nephrotic syndrome. J Vet Intern Med.
h Increased Total
inflammatory bowel disease, 2011;25(2):206-214.
Thyroxine Latimer KL, Prasse KW. Proteins, lipids, and carbo-
lymphangiectasia) hydrates. In: Latimer KS, Mahaffey EA, Prasse KW,
h Hypoglycemia
• H emorrhage eds. Duncan and Prasse’s Veterinary Laboratory
h Epistaxis Medicine: Clinical Pathology. 4th ed. Ames, IA:
h Regurgitation • S evere exudative dermatitis (eg, Blackwell Publishing Professional; 2003:173-182.
large burns or wounds, snakebites) Lester C, Cooper J, Peters RM, Webster CR. Retro-
spective evaluation of acute liver failure in dogs
h Decreased production (1995-2012): 49 cases. J Vet Emerg Crit Care (San
Antonio). 2016;26(4):559-567.
• A cute phase reaction (albumin is
Pointer E, Reisman R, Windham R, Murray L. Star-
a negative acute phase protein) vation and the clinicopathologic abnormalities
associated with starved dogs: a review of 152
• L iver dysfunction/failure cases. J Am Anim Hosp Assoc. 2013;49(2):101-107.
• S econdary to hyperglobulinemia Soare T, Noble PJ, Hetzel U, Fonfara S, Kipar A.
Paraneoplastic syndrome in haemophagocytic
(ie, albumin is downregulated due histiocytic sarcoma in a dog. J Comp Pathol.
to increased oncotic pressure from 2012;146(2-3):168-174.
Stockham SL, Scott MA. Proteins. In: Stockham SL,
increased globulins) Scott MA. Fundamentals of Veterinary Clinical Pa-
• S
tarvation (ie, chronic, severe thology. 2nd ed. Ames, IA: Blackwell Publishing;
2008:370-392.
malnutrition) Stranieri A, Giordano A, Bo S, Braghiroli C, Paltrinieri
h Excessive fluids (dilutional effect) S. Frequency of electrophoretic changes con-
sistent with feline infectious peritonitis in two
h Hypoadrenocorticism different time periods (2004-2009 vs 2013-2014).
h Sequestration (eg, secondary to J Feline Med Surg. 2017;19(8):880-887.
Wakayama JA, Furrow E, Merkel LK, Armstrong PJ. A
loss in protein-rich effusions), retrospective study of dogs with atypical hypoad-
third-spacing renocorticism: a diagnostic cut-off or continuum?
J Small Anim Pract. 2017;58(7):365-371.
h Hemophagocytic histiocytic Wennogle S, Priestnall SL, Webb CB. Histopathologic
sarcoma characteristics of intestinal biopsy samples from
dogs with chronic inflammatory enteropathy
h Increased catabolism (poorly with and without hypoalbuminemia. J Vet Intern
Med. 2017;31(2):371-376.
characterized) n
April 2019 cliniciansbrief.com 21NADA 141-426, Approved by FDA NADA 141-459, Approved by FDA NADA 141-459, Approved by FDA
(fluralaner topical solution) for Dogs (fluralaner topical solution) for Cats
Flavored chews for dogs. BRIEF SUMMARY (For full Prescribing Information, see package insert)
BRIEF SUMMARY (For full Prescribing Information, see package insert)
BRIEF SUMMARY (For full Prescribing Information, see package insert) Caution: Caution:
Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed
Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.
Federal (USA) law restricts this drug to use by or on the order of a veterinarian.
licensed veterinarian. Indications:
Indications: Bravecto kills adult fleas and is indicated for the treatment and prevention of
Indications: Bravecto kills adult fleas and is indicated for the treatment and prevention of flea flea infestations (Ctenocephalides felis) and the treatment and control of Ixodes
Bravecto kills adult fleas and is indicated for the treatment and prevention infestations (Ctenocephalides felis) and the treatment and control of tick infestations scapularis (black-legged tick) infestations for 12 weeks in cats and kittens 6
[Ixodes scapularis (black-legged tick), Dermacentor variabilis (American dog tick), and months of age and older, and weighing 2.6 pounds or greater.
of flea infestations (Ctenocephalides felis) and the treatment and control of Rhipicephalus sanguineus (brown dog tick)] for 12 weeks in dogs and puppies 6 months
tick infestations [Ixodes scapularis (black-legged tick), Dermacentor variabilis of age and older, and weighing 4.4 pounds or greater. Bravecto is also indicated for the treatment and control of Dermacentor variabilis
(American dog tick), and Rhipicephalus sanguineus (brown dog tick)] for 12 (American dog tick) infestations for 8 weeks in cats and kittens 6 months of age
Bravecto is also indicated for the treatment and control of Amblyomma and older, and weighing 2.6 pounds or greater.
weeks in dogs and puppies 6 months of age and older, and weighing 4.4 americanum (lone star tick) infestations for 8 weeks in dogs and puppies 6
pounds or greater. months of age and older, and weighing 4.4 pounds or greater. Contraindications:
There are no known contraindications for the use of the product.
Bravecto is also indicated for the treatment and control of Amblyomma Contraindications:
There are no known contraindications for the use of the product. WARNINGS
americanum (lone star tick) infestations for 8 weeks in dogs and puppies 6 Human Warnings:
months of age and older, and weighing 4.4 pounds or greater. WARNINGS Not for human use. Keep this and all drugs out of the reach of children. Do
Human Warnings: not contact or allow children to contact the application site until
Contraindications: dry. Keep the product in the original packaging until use in order to prevent
There are no known contraindications for the use of the product. Not for human use. Keep this and all drugs out of the reach of children. Do
not contact or allow children to contact the application site until children from getting direct access to the product. Do not eat, drink or smoke
Warnings: dry. Keep the product in the original packaging until use in order to prevent while handling the product. Avoid contact with skin and eyes. If contact with
children from getting direct access to the product. Do not eat, drink or smoke eyes occurs, then flush eyes slowly and gently with water. Wash hands and
Not for human use. Keep this and all drugs out of the reach of children. Keep contacted skin thoroughly with soap and water immediately
the product in the original packaging until use, in order to prevent children from while handling the product. Avoid contact with skin and eyes. If contact with
eyes occurs, then flush eyes slowly and gently with water. Wash hands and after use of the product.
getting direct access to the product. Do not eat, drink or smoke while handling The product is highly flammable. Keep away from heat, sparks, open flame or
contacted skin thoroughly with soap and water immediately
the product. Wash hands thoroughly with soap and water immediately after after use of the product. other sources of ignition.
use of the product.
The product is highly flammable. Keep away from heat, sparks, open flame or Precautions:
Precautions: other sources of ignition. For topical use only. Avoid oral ingestion. Use with caution in cats with a
Bravecto has not been shown to be effective for 12-weeks duration in puppies Precautions: history of neurologic abnormalities. Neurologic abnormalities have been
less than 6 months of age. Bravecto is not effective against Amblyomma reported in cats receiving Bravecto, even in cats without a history of neurologic
For topical use only. Avoid oral ingestion. Use with caution in dogs with a history abnormalities. Bravecto has not been shown to be effective for 12-weeks
americanum ticks beyond 8 weeks after dosing. of seizures. Seizures have been reported in dogs receiving fluralaner, even in duration in kittens less than 6 months of age. Bravecto is not effective against
dogs without a history of seizures. Bravecto has not been shown to be effective Dermacentor variabilis ticks beyond 8 weeks after dosing. The safety of Bravecto
Adverse Reactions: for 12-weeks duration in puppies less than 6 months of age. Bravecto is not has not been established in breeding, pregnant and lactating cats.
In a well-controlled U.S. field study, which included 294 dogs (224 dogs were effective against Amblyomma americanum ticks beyond 8 weeks after dosing.
administered Bravecto every 12 weeks and 70 dogs were administered an oral Adverse Reactions:
Adverse Reactions: In a well-controlled U.S. field study, which included a total of 161 households
active control every 4 weeks and were provided with a tick collar); there were no In a well-controlled U.S. field study, which included a total of 165 households and 311 treated cats (224 with fluralaner and 87 with a topical active control),
serious adverse reactions. All potential adverse reactions were recorded in dogs and 321 treated dogs (221 with fluralaner and 100 with a topical active control), there were no serious adverse reactions.
treated with Bravecto over a 182-day period and in dogs treated with the active there were no serious adverse reactions.
Percentage of Cats with Adverse Reactions (AR) in the Field Study
control over an 84-day period. The most frequently reported adverse reaction in Percentage of Dogs with Adverse Reactions in the Field Study
dogs in the Bravecto and active control groups was vomiting. Bravecto Group: Control Group:
Bravecto Group: Control Group: Percent of Cats Percent of Cats with
Percentage of Dogs with Adverse Reactions in the Field Study Adverse Reaction
Adverse Reaction Percent
of Dogs with Percent of Dogs with with the AR During the AR During the
the AR During the the AR During the (AR)
Bravecto Group: (AR) the 105-Day Study 84-Day Study
Active Control Group: 105-Day Study 84-Day Study
Percentage of Dogs (n=224 cats) (n=87 cats)
Percentage of Dogs (n=221 dogs) (n=100 dogs)
Adverse with the AR During Vomiting 7.6% 6.9%
with the AR During the Vomiting 6.3% 6.0%
Reaction (AR) the Pruritus 5.4% 11.5%
84-Day Study Alopecia 4.1% 2.0%
182-Day Study Diarrhea 4.9% 1.1%
(n=70 dogs) Diarrhea 2.7% 11.0%
(n=224 dogs)
Alopecia 4.9% 4.6%
Vomiting 7.1 14.3 Lethargy 2.7% 2.0%
Decreased Appetite 3.6% 0.0%
Decreased Appetite 6.7 0.0 Decreased Appetite 1.4% 0.0%
Lethargy 3.1% 2.3%
Diarrhea 4.9 2.9 Moist Dermatitis/Rash 0.9% 0.0%
Scabs/Ulcerated
Lethargy 5.4 7.1 2.2% 3.4%
In the field study, two dogs treated with Bravecto with no prior history of seizures Lesions
Polydipsia 1.8 4.3 each experienced a seizure. One dog had two seizures a day apart about 18 days In the field study, two cats treated with fluralaner topical solution experienced
after its first dose. The dog was started on antiepileptic medication and had no ataxia. One cat became ataxic with a right head tilt 34 days after the first
Flatulence 1.3 0.0 additional seizures during the study. A second dog had a seizure 76 days after its dose. The cat improved within one week of starting antibiotics. The ataxia
In a well-controlled laboratory dose confirmation study, one dog developed first dose and 3 days after starting fluoxetine for separation anxiety. The fluoxetine and right head tilt, along with lateral recumbency, reoccurred 82 days after
edema and hyperemia of the upper lips within one hour of receiving Bravecto. was discontinued and the dog experienced no additional seizures during the administration of the first dose. The cat recovered with antibiotics and was
The edema improved progressively through the day and had resolved without study. One dog treated with Bravecto was observed by the owner to be off balance redosed with fluralaner topical solution 92 days after administration of the first
medical intervention by the next morning. for about 30 minutes five days after its first dose and had no similar observations dose, with no further abnormalities during the study. A second cat became
after the second dose. One dog with a history of seizures had a seizure the day ataxic 15 days after receiving its first dose and recovered the next day. The cat
For technical assistance or to report a suspected adverse drug reaction, contact after the second dose of the active control. was redosed with fluralaner topical solution 82 days after administration of the
Merck Animal Health at 1-800-224-5318. Additional information can be found at In two well-controlled laboratory dose confirmation studies, one dog developed first dose, with no further abnormalities during the study.
www.bravecto.com. For additional information about adverse drug experience mild to moderate redness, flaking, crusts/scabs and alopecia at the treatment In a European field study, two cats from the same household experienced
reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http:// site from Day 1 through 14 after application of Bravecto on Day 0, and one dog tremors, lethargy, and anorexia within one day of administration. The signs
www.fda.gov/AnimalVeterinary/SafetyHealth. developed self-limiting generalized erythema (possible allergic reaction) one resolved in both cats within 48-72 hours.
day after treatment with Bravecto.
In a European field study, there were three reports of facial dermatitis in
How Supplied: In a European field study in cats, there were three reports of facial dermatitis humans after close contact with the application site which occurred within 4
Bravecto is available in five strengths (112.5, 250, 500, 1000, and 1400 mg in humans after close contact with the application site which occurred within 4 days of application.
fluralaner per chew). Each chew is packaged individually into aluminum foil days of application.
For technical assistance or to report a suspected adverse drug reaction, or to
blister packs sealed with a peelable paper backed foil lid stock. Product may be For technical assistance or to report a suspected adverse drug reaction, or to obtain a obtain a copy of the Safety Data Sheet (SDS), contact Merck Animal Health
packaged in 1, 2, or 4 chews per package. copy of the Safety Data Sheet (SDS), contact Merck Animal Health at 1-800-224-5318. at 1-800-224-5318. Additional information can be found at www.bravecto.
Additional information can be found at www.bravecto.com. For additional information com. For additional information about adverse drug experience reporting for
Distributed by: about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA- animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/
Intervet Inc (d/b/a Merck Animal Health) VETS or online at http://www.fda.gov/AnimalVeterinary/SafetyHealth. AnimalVeterinary/SafetyHealth.
Madison, NJ 07940 How Supplied: How Supplied:
Made in Austria Bravecto is available in five strengths for use in dogs (112.5, 250, 500, 1000, Bravecto is available in three strengths for use in cats (112.5, 250, and 500 mg
and 1400 mg fluralaner per tube). Each tube is packaged individually in a fluralaner per tube). Each tube is packaged individually in a pouch. Product may
Copyright © 2014 Intervet Inc, a subsidiary of Merck & Company Inc. pouch. Product may be supplied in 1 or 2 tubes per carton.
All rights reserved be supplied in 1 or 2 tubes per carton.
154545 R1 Distributed by: Distributed by:
Intervet Inc (d/b/a Merck Animal Health) Intervet Inc (d/b/a Merck Animal Health)
Madison, NJ 07940 Madison, NJ 07940
Made in the USA. Made in the USA.
Rev. 9/16 Rev. 9/16
Copyright © 2016 Intervet Inc, a subsidiary of Merck & Company Inc. Copyright © 2016 Intervet Inc, a subsidiary of Merck & Company Inc.
All rights reserved All rights reserved
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